Doctors' union should be last resort

Posted: Thursday, July 01, 1999

Given the fact that some physicians already belong to unions and the likelihood that many will never join, last week's move by the American Medical Association to form its own doctors' union is not as alarming as it might have seem at first blush.

Most Americans are unaware that between 2 percent and 6 percent - mostly interns and residents or physicians working directly for hospitals and HMOs - of the nation's 600,000 active doctors belong to unions.

Physicians in private practice are prohibited by federal law from organizing into unions. But last week's action by the AMA is seen as a step toward getting around anti-trust laws.

The AMA hopes to have the status of thousands of doctors changed in the eyes of the National Labor Relations Board from mangers and owners of their own businesses to employees of HMOs, and thus eligible to form unions.

The realization that some doctors already engage in collective bargaining does little to diminish our repugnance at the thought of physicians on the picket line or of sick patients left unattended during a strike.

Nor is it comforting to envision doctors who make four or five times as much per year as the average American putting health care in peril as they negotiate for a few dollars more.

The physicians say it isn't all about money. They say it's mostly about standing up to managed health care organizations and insurance companies and being able to give patients the best possible care.

Without a doubt, the growing influence of HMOs has a lot to do with the AMA's decision to sanction a physicians' union. Most of us are willing to believe that doctors have legitimate concerns about health care protocol being dictated by the for-profit businesses.

MDs as individuals seldom have the kind of power necessary to persuade HMOs to change policies and procedures. But as a collective unit, a union will be in a position to negotiate treatment options, hospital stays for patients, choices of prescribed medications and other issues.

In that context, last week's action by the AMA's House of Delegates should serve as a shot across the bow of the HMOs, a warning that they may have gone too far in their cost-cutting efforts.

But there can be no denying that this initiative also is about money. Doctors are worried about patients, but they're also worried about the impact HMOs have on their pocketbooks and their lifestyles.

The physicians aren't likely to get much sympathy from patients on that count. Just like the doctors, many of them have been caught in the squeeze caused by efforts to control medical costs.

Long before the doctors felt the financial pinch, health care consumers were forced to face increased insurance premiums, pay higher deductibles and otherwise pick up a bigger portion of doctor and hospital bills.

Unionization efforts will only add to the patients' burdens.

Insurers and managed care companies say collective bargaining by doctors could boost premiums by another 10 percent and make insurance unaffordable for another 2 million people.

Even if doctors don't strike or engage in work stoppages or boycotts, the consumer will be the losers if physicians' unions are allowed to fix salaries and fees for their members.

The AMA and its members have some valid complaints about their relationships with the HMOs and insurance companies, but forming a union is a radical approach that should only be considered after all other options for working out differences have been exhausted.

The health care of Americans is too vital an issue to be put in jeopardy by collective bargaining negotiations.